Summary: People who frequently take sleeping medications are 79% more likely to develop dementia than those who never use sleeping pills to aid their rest.
A new study shows that sleep medications increase the risk of dementia in whites. But the type and quantity of the medication may be factors in explaining the higher risk.
It follows previous work that shows Blacks have a higher likelihood than whites of developing Alzheimer’s, the most common type of dementia, and that they have different risk factors and disease manifestation.
The final corrected draft of the study publishes in the Journal of Alzheimer’s Disease on Jan. 31, 2023.
In the study, approximately 3,000 older adults without dementia, who lived outside of nursing homes, were enrolled in the Health, Aging and Body Composition study and followed over an average duration of nine years. Their average age was 74; 42% were Black and 58% were white.
During the study, 20% developed dementia. White participants who “often” or “almost always” took sleep medications had a 79% higher chance of developing dementia compared to those who “never” or “rarely” used them. Among Black participants – whose consumption of sleep aids was markedly lower – frequent users had a similar likelihood of developing dementia than those who abstained or rarely used the medications.
Higher-Income Blacks May Be Less Likely to Get Dementia
“Differences may be attributed to socio-economic status” said first author Yue Leng, PhD, of the UCSF Department of Psychiatry and Behavioral Sciences and Weill Institute for Neurosciences.
“Black participants who have access to sleep medications might be a select group with high socio-economic status and, thus, greater cognitive reserve, making them less susceptible to dementia.
“It’s also possible that some sleep medications were associated with a higher risk of dementia than others.”
The researchers found that whites, at 7.7%, were three times as likely as Blacks, at 2.7%, to take sleep medications often, five to 15 times a month, or almost always, 16 times a month to daily. Whites were almost twice as likely to use benzodiazepines, like Halcion, Dalmane and Restoril, prescribed for chronic insomnia.
Whites were also 10 times as likely to take trazodone, an antidepressant known by the trade names of Desyrel and Oleptro, that may also be prescribed as a sleep aid. And they were more than seven times as likely to take “Z-drugs,” such as Ambien, a so-called sedative-hypnotic.
While future study may offer clarity on the cognitive risks or rewards of sleep medications and the role that race may play, patients with poor sleep should hesitate before considering medications, according to Leng.
“The first step is to determine what kind of sleep issues patients are dealing with. A sleep test may be required if sleep apnea is a possibility,” she said. “If insomnia is diagnosed, cognitive behavioral therapy for insomnia (CBT-i) is the first-line treatment. If medication is to be used, melatonin might be a safer option, but we need more evidence to understand its long-term impact on health.”
Authors: Senior author is Kristine Yaffe, MD, of the UCSF Departments of Psychiatry and Behavioral Sciences, Neurology and Epidemiology. Co-author is Katie L. Stone, PhD, Department of Research Institute, California Pacific Medical Center, San Francisco.
Funding and Disclosures: Research was supported by the UCSF Claude D. Pepper Older Americans Independence Center, funded by National Institute on Aging, P30 AG044281. Dr. Yue Leng is supported by the National Institute on Aging (NIA), R00 AG056598. Authors’ disclosures are available online.
About this neuropharmacology and dementia research news
Author: Suzanne Leigh
Contact: Suzanne Leigh – UCSF
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Original Research: Closed access.
“Race Differences in the Association Between Sleep Medication Use and Risk of Dementia” by Yue Leng et al. Journal of Alzheimer’s Disease
Race Differences in the Association Between Sleep Medication Use and Risk of Dementia
Background: The effect of sleep medications on cognition in older adults is controversial, possibly dependent upon sleep quality, and may differ by race. Objective:To determine the longitudinal association between sleep medication use and incident dementia over 15 years, and to explore whether the association is independent of nighttime sleep disturbances and if it differs by race.
Methods: We examined 3,068 community-dwelling older adults (aged 74.1±2.9 years, 41.7% Black, 51.5% female) without dementia. Sleep medication use was recorded three times by asking “Do you take sleeping pills or other medications to help you sleep?” with the response options: “Never (0)”, “Rarely (≤1/month)”, “Sometimes (2–4/month)”, “Often (5–15/month)”, or “Almost Always (16–30/month)”. Incident dementia was defined using hospitalization records, dementia medication prescription or clinically significant decline in global cognition.
Results: 138 (7.71%) of Whites and 34 (2.66%) of Blacks reported taking sleep medications “often or almost always”. Whites were almost twice as likely to take all prescription hypnotics. 617 participants developed dementia over the follow-up. After adjustment for all covariates, participants who reported taking sleep medications ≥ 5/month versus ≤1/month were significantly more likely to develop dementia, and the association was only observed among Whites (HR = 1.79,1.21–2.66) but not Blacks (HR = 0.84,0.38–1.83); p for interaction = 0.048. Further adjustment for nighttime sleep did not appreciably alter the results. The association was similar for the cumulative frequency of sleep medication use and remained after introducing a time lag of 3 years.
Conclusion: Frequent sleep medication use was associated with an increased risk of dementia in White older adults. Further research is needed to determine underlying mechanisms.